"Choosing Wisely" Diagnostic Tests in Chronic Urticaria: Does Screening for H. Pylori, Vitamin D Deficiency and Anti-Fceri Antibodies Have a Role?

Chronic urticaria (CU) is a common and potentially disabling clinical condition; the utility of laboratory investigation in CU is unclear. We summarized a diagnostic approach including history, physical examination, and a screening panel of H. pylori IgG, vitamin D, and anti-FceRI antibodies (Ab). H. pylori infection and vitamin D deficiency are treatable, while anti-FceRI Ab aid in prognostication in terms of disease severity and duration. A retrospective chart review included 29 adults referred to a tertiary care center because of CU perceived as difficult to treat by referring physicians. Review included demographics and history (duration of CU, angioedema, and dermatographism), with a diagnostic panel of H. pylori IgG, 25-OH vitamin D level, and anti-FceRI Ab. Age range 19 to 72 years; 24 female, 5 male. Duration of CU ranged from 6 weeks to 20 years, 14/28 (50%) with duration > 1 year. A total of 15/29 (51%) patients had history of angioedema and 3/9 (33%) had dermatographism. Diagnostic testing revealed 7/27 (26%) patients had +H. pylori IgG, 8/27 (30%) had +anti-FceRI Ab, and 6/19 (32%) had 25-OH vitamin D levels 10-25 ng/mL. Patients without documentation of lab values were omitted from calculation of percentages. The utilization of a limited diagnostic screening panel in adults with severe CU yielded positive results that allowed further treatment options, such as treatment of H. pylori (26%), vitamin D deficiency (32%), and the diagnosis of chronic autoimmune urticaria (30%). A prospective study is warranted to analyze the outcomes and cost analysis of this testing approach.